Decision Date: 07/17/95 Archive Date: 01/17/96
DOCKET NO. 93-16 986 ) DATE
)
)
On appeal from the decision of the
Department of Veterans Affairs Regional Office in Los
Angeles, California
THE ISSUE
Entitlement to service connection for heart disease.
REPRESENTATION
Appellant represented by: California Department of
Veterans Affairs
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Ronald R. Bosch, Counsel
INTRODUCTION
The veteran served on active duty from May 1959 to August
1959, and from February 1962 to September 1984.
This appeal arose from a December 1990 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Los Angeles, California. The RO denied entitlement to
service connection for heart disease.
The case has been forwarded to the Board of Veterans’ Appeals
(Board) for appellate review.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that chest pains reported during his
active service were the first indication of onset of heart
disease formally diagnosed after service, thereby warranting
entitlement to a grant of service connection. He argues that
his cardiovascular symptoms have been present since service
and that his post service reported heart disease cannot be
dissociated from his service.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991), has reviewed and considered all of the
evidence and material of record in the veteran's claims file.
Based on its review of the relevant evidence in this matter,
and for the following reasons and bases, it is the decision
of the Board that the preponderance of the evidence is
against a grant of entitlement to service connection for
heart disease.
FINDINGS OF FACT
1. Heart disease was not shown during service.
2. Heart disease was not disabling to a compensable degree
during the first post service year.
3. Heart disease was not diagnosed until several years
following service.
CONCLUSION OF LAW
Heart disease was not incurred in or aggravated by active
service; nor may it be presumed to have been incurred during
such service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131,
1137, 5107 (West 1991); 38 C.F.R. §§ 3.303(b), 3.307, 3.309
(1994).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Initially, the Board finds that the veteran has presented
evidence of a well grounded claim within the meaning of
38 U.S.C.A. § 5107(a), in that he has presented a claim which
is plausible. The Board is satisfied that all relevant facts
have been properly developed, and that no further assistance
to the veteran is required in order to comply with
38 U.S.C.A. § 5107(a).
A review of the service medical records discloses that in
August 1974 the veteran reported with complaints of
symptomatology including occasional heart palpitations,
diaphoresis, and rapid breathing when he got black out
spells. An electrocardiogram was normal. A clinical
inspection of the heart disclosed no murmur, gallop, rub,
heave, or thrill. The lungs were clear to auscultation and
percussion. The diagnostic impressions included blackouts
secondary to hyperventilation and/or alcohol.
In April 1976 the appellant underwent blood pressure testing
to rule out hypertension. On April 27 blood pressure
readings reported in the morning were as follows: recumbent,
146/100; standing, 136/90; and sitting, 130/100. Blood
pressure readings reported in the afternoon were as follows:
recumbent, 126/92, standing, 130/92, and sitting, 124/90.
Blood pressure readings reported on April 28 in the morning
were as follows: recumbent, 134/94, standing, 128/90, and
sitting, 132/100. Blood pressure readings reported in the
afternoon were as follows: recumbent, 130/88, standing,
118/94, and sitting, 118/84. On April 29 blood pressure
readings reported in the morning were as follows: recumbent,
136/96, standing, 130/94, and sitting, 126/100. Blood
pressure readings reported in the afternoon were as follows:
recumbent, 130/84, standing, 120/78, and sitting, 126/82.
Hypertension was not diagnosed.
In November 1978 the appellant reported with complaints of
symptomatology including dizzy spells. He was noted to have
a history of cardiac problems. Blood pressure readings were
as follows: 118/78, 110/80, 110/80, 130/80, and 126/78. The
examiner noted the veteran had a long history of blackout
spells. His symptoms lasted about two seconds and were
accompanied by tachycardia without palpitations and with
sharp apical chest pain lasting about five seconds. The
clinical assessment was orthostatic dizziness with no
evidence of cardiovascular pathology. The examiner noted
that apparent vascular compromise appeared minimal. There
was no evidence of marked vascular disease. The
electrocardiogram was reported as normal. The May 1984
examination for release from active duty shows normal
clinical evaluations of the heart and vascular system. Blood
pressure was 118/80.
The claimant was evaluated for chest pain and tachycardia at
a military medical facility from March to July 1985.
Diagnostic studies concluded in a finding of Lown-Genong-
Levine Syndrome. The appellant was given Inderal and became
asymptomatic.
The appellant was hospitalized at a private medical center in
May 1990 for a
syncopal episode. An electrocardiogram was interpreted as
normal.
The veteran was hospitalized by VA in June 1990 to rule out
arrhythmia. Heart disease was not found.
An August 1990 VA general medical examination of the
cardiovascular system disclosed no abnormalities and heart
disease was not diagnosed.
The veteran was hospitalized by VA in June 1991 at which time
he underwent a coronary artery bypass graft. He was
diagnosed with coronary artery disease.
The appellant was privately hospitalized in January 1992 for
treatment of an acute myocardial infarction. He underwent a
four vessel coronary artery bypass graft.
The veteran provided testimony at an RO hearing held in June
1992. He testified that he was not told he had a heart
condition in service. On one occasion he was told that he
had borderline hypertension; however, he was never placed on
medication. The appellant testified that from 1985 to 1991
he experienced numbness in his legs and chest pain lasting
three to five minutes approximately twice a year. He did not
seek treatment for his symptoms.
The Board’s evaluation of the evidence of the record does not
permit a conclusion that service connection is warranted for
heart disease. During service the veteran was evaluated on
occasion for a complex of symptomatology which included
features that were considered as possibly suggestive of heart
disease. In fact, he was noted on one occasion to have a
history of heart problems. However, the evaluations in
service never concluded in a diagnosis or finding of heart
disease.
The veteran was monitored over a three day period in April
1976 to rule out hypertension. None of his systolic readings
either reached or exceeded 150. While
some of his diastolic readings exceeded 90, subsequent
readings returned to less than 90, and later dated blood
pressure readings were all less than 150 systolic and less
than 90 diastolic. Neither hypertension nor heart disease
was ever diagnosed in service, and the examination conducted
prior to separation from service was negative for any
cardiovascular abnormalities.
The veteran’s treatment for chest pain at a military medical
facility during 1985 never concluded in a finding of heart
disease. Heart disease was not shown when the veteran was
evaluated on an outpatient basis by VA in June 1990, nor when
he was examined by VA in August 1990. The veteran was
initially treated for coronary artery disease when he
underwent a coronary artery bypass graft when hospitalized by
VA in June 1991. He was treated for a myocardial infarction
at a private medical facility in January 1992.
As can be seen from the foregoing discussion, the veteran was
never shown to have heart disease per se during his active
service, but initially found to have coronary artery disease
in 1990, approximately six years following service. While
the appellant has contended that he experienced
cardiovascular symptomatology during his immediate post
service years until he was diagnosed with coronary artery
disease, he has acknowledged that he never sought treatment
for his symptoms. The veteran is not a medical doctor and
therefore is not competent to identify the source of
symptomatology. Thus the gap between his immediate post
service years and later development of heart disease with
respect to continuity of symptomatology cannot be bridged by
competent medical documentation.
It is the judgment of the Board that the record does not
support a grant of entitlement to service connection for
heart disease. 38 U.S.C.A. §§ 1101, 1110,
1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.303(b), 3.307,
3.309.
ORDER
Entitlement to service connection for heart disease is
denied.
BRUCE KANNEE
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on appeal
is appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the agency
of original jurisdiction on or after November 18, 1988.
Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402
(1988). The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision
which you have received is your notice of the action taken on
your appeal by the Board of Veterans' Appeals.
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